Patients with severe polytrauma: management and imaging protocols.

Traumatic injuries can be severe and complex, requiring the coordinated efforts of a multidisciplinary team. Imaging tests play a fundamental role in rapid and accurate diagnosis. In particular, whole-body computed tomography (CT) has become a key tool. There are different CT protocols depending on the patient's condition; whereas dose-optimized protocols can be used in stable patients, time/precision protocols prioritizing speed at the cost of delivering higher doses of radiation should be used in more severe patients. In unstable patients who cannot be examined by CT, X-rays of the chest and pelvis and FAST or e-FAST ultrasound studies, although less sensitive than CT, enable the detection of situations that require immediate treatment. This article reviews the imaging techniques and CT protocols for the initial hospital workup for patients with multiple trauma.

Update on acute appendicitis: Typical and untypical findings.

Acute appendicitis is the most common indication for emergency abdominal surgery throughout the world and a common reason for consultation in emergency departments. In recent decades, diagnostic imaging has played a fundamental role in identifying acute appendicitis, helping to reduce the rate of blind laparotomies and hospital costs. Given the results of clinical trials supporting the use of antibiotic therapy over surgical treatment, radiologists need to know the diagnostic criteria for complicated acute appendicitis to be able to recommend the best treatment option. This review aims not only to define the diagnostic criteria for appendicitis in different imaging modalities (ultrasonography, computed tomography, and magnetic resonance imaging), but also to explain the diagnostic protocols, atypical presentations, and other conditions that can mimic appendicitis.

The usefulness and positive predictive value of ultrasonography and computed tomography in the diagnosis of acute appendicitis in adults: A retrospective study.

OBJECTIVE: To analyze the evolution of the use of imaging tests (ultrasonography and computed tomography (CT)) in the diagnosis of acute appendicitis. To determine the positive predictive value of these tests and the percentage of negative and complicated appendectomies. MATERIAL AND METHODS: This retrospective study compared adults who underwent appendectomy for suspected acute appendicitis at our tertiary hospital during 2015 versus similar patients at our center during 2007. RESULTS: A total of 278patients were included. The rate of negative appendectomies descended to 5%. The positive predictive value of ultrasonography increased to 97.4% in 2015, and the positive predictive value of CT and combined CT and ultrasonography was 100%. The rate of complicated appendicitis increased (23% in 2015). CONCLUSIONS: The use of imaging tests increased, and the rate of "blind" laparotomies decreased. Nevertheless, the rate of complicated appendicitis increased.

Estudio retrospectivo y comparativo de la utilidad y del valor predictivo positivo de la ecografía y la tomografía computarizada en el diagnóstico de apendicitis aguda en adultos / The usefulness and positive predictive value of ultrasonography vs. computed tomography in the diagnosis of acute appendicitis in adults: a retrospective study

Objetivo: Analizar la evolución del uso de pruebas de imagen (ecografía y tomografía computarizada [TC]) en el diagnóstico de apendicitis aguda, el valor predictivo positivo (VPP) y determinar el porcentaje de apendicectomías negativas y complicadas. Material y métodos: Estudio retrospectivo que incluye a los pacientes adultos con apendicectomía por sospecha de apendicitis aguda en 2015 en un hospital terciario. Se compara con los del 2007 publicados previamente. Resultados: La muestra incluye 278 pacientes. La tasa de apendicectomías negativas descendió a un 5%. El VPP de la ecografía aumentó a 97,4% en 2015 y el VPP de la TC y del uso combinado de la ecografía y la TC fue del 100%. El porcentaje de apendicitis complicadas se incrementó (23% en 2015). Conclusiones: Se observó un aumento en el empleo de pruebas de imagen y una disminución de laparotomías en blanco. No obstante, las apendicitis complicadas se han incrementado.(AU)

Objective: To analyze the evolution of the use of imaging tests (ultrasonography and computed tomography (CT)) in the diagnosis of acute appendicitis. To determine the positive predictive value of these tests and the percentage of negative and complicated appendectomies. Material and methods: This retrospective study compared adults who underwent appendectomy for suspected acute appendicitis at our tertiary hospital during 2015 versus similar patients at our center during 2007. Results: A total of 278 patients were included. The rate of negative appendectomies descended to 5%. The positive predictive value of ultrasonography increased to 97.4% in 2015, and the positive predictive value of CT and combined CT and ultrasonography was 100%. The rate of complicated appendicitis increased (23% in 2015). Conclusions: The use of imaging tests increased, and the rate of “blind” laparotomies decreased. Nevertheless, the rate of complicated appendicitis increased.(AU)

Radiologic diagnosis of patients with COVID-19. / Diagnóstico radiológico del paciente con COVID-19.

The pandemia caused by the SARS-CoV-2 virus has triggered an unprecedented health and economic crisis. Although the diagnosis of infection with SARS-CoV-2 is microbiological, imaging techniques play an important role in supporting the diagnosis, grading the severity of disease, guiding treatment, detecting complications, and evaluating the response to treatment. The lungs are the main organ involved, and chest X-rays, whether obtained in conventional X-ray suites or with portable units, are the first-line imaging test because they are widely available and economical. Chest CT is more sensitive than plain chest X-rays, and CT studies make it possible to identify complications in addition to pulmonary involvement, as well as to suggestive alternative diagnoses. The most common radiologic findings in COVID-19 are airspace opacities (consolidations and/or ground-glass opacities), which are typically bilateral, peripheral, and located primarily in the lower fields.

Pulmonary embolisms in patients with COVID-19: a prevalence study in a tertiary hospital. / Tromboembolismo pulmonar en pacientes con COVID-19: estudio de prevalencia en un hospital terciario.

INTRODUCTION: SARS-CoV-2, the virus responsible for the current pandemic, predominantly affects the respiratory tract, and a growing number of publications report the predisposition of patients with COVID-19 to develop thrombotic phenomena. OBJECTIVE: To determine the prevalence of pulmonary embolism in patients with COVID-19; to determine the possible relationship between the severity of pulmonary involvement and D-dimer levels; to analyze the location of pulmonary embolisms in patients with COVID-19 and to compare it with the location in patients without COVID-19. METHODS: This retrospective study analyzed all CT angiograms of the pulmonary arteries done in patients with suspected pulmonary embolisms between March 15 and April 30, 2020 and compared them with studies done in the same period one year earlier. RESULTS: We included 492 pulmonary CT angiograms (342 (69.9%) in patients with COVID-19 and 147 (30.1%) in patients without COVID-19). The prevalence of pulmonary embolisms was higher in patients with COVID-19 (26% vs. 16.3% in patients without COVID-19, p=0.0197; relative risk=1.6). The prevalence of pulmonary embolisms in the same period in 2019 was 13.2%, similar to that of the group of COVID-19-negative patients in 2020 (p=0.43). There were no significant differences in D-dimer levels or the location of pulmonary embolisms between the two groups. CT showed moderate or severe pulmonary involvement in 78.7% of the patients with COVID-19. CONCLUSIONS: Patients with COVID-19 have an increased prevalence of pulmonary embolisms (26%), and most (78.7%) have moderate or severe lung involvement on CT studies. The location of pulmonary embolisms and the degree of elevation of D-dimer levels does not differ between patients with COVID-19 and those without.

Puerperal complications: pathophysiological mechanisms and main imaging findings. / Complicaciones del puerperio: mecanismos fisiopatológicos y principales hallazgos radiológicos asociados.

OBJECTIVE: Puerperium is the period during which the physiological changes that have taken place during pregnancy revert and the uterus involutes until it reaches its normal size. This is a period of intense systemic changes, and diagnosing complications in this period is a challenge for both gynecologists and radiologists. This paper reviews the complications that can occur during puerperium, classifying them according to the pathophysiological mechanisms involved: the prothrombotic state, hemodynamic and hormonal changes, rapid uterine growth, changes associated with endothelial damage (preeclampsia, eclampsia, and HELLP syndrome), and postoperative complications in patients undergoing cesarean sections. CONCLUSION: Puerperal complications represent a diagnostic challenge. Understanding the pathophysiological mechanisms underlying these complications is fundamental for choosing the most appropriate imaging technique to ensure the correct diagnosis in each case.

Diagnóstico radiológico del paciente con COVID-19 / Radiologic diagnosis of patients with COVID-19

La pandemia por el virus SARS-CoV-2ha desencadenado una crisis económica y sanitaria sin precedentes. Aunque el diagnóstico es microbiológico, las técnicas de imagen tienen un papel importante para apoyar el diagnóstico, graduar la gravedad de la enfermedad, guiar el tratamiento, detectar posibles complicaciones y valorar la respuesta terapéutica. La afectación es principalmente pulmonar. La radiografía de tórax en sala convencional o portátil es el primer método de imagen por su amplia disponibilidad y bajo coste. La tomografía computarizada torácica tiene una mayor sensibilidad que la radiografía de tórax y permite valorar tanto la afectación pulmonar como posibles complicaciones, además de proporcionar diagnósticos alternativos. Los hallazgos radiológicos más frecuentes son las opacidades del espacio aéreo en forma de consolidaciones y/u opacidades en vidrio deslustrado, con distribución típicamente bilateral, periférica y de predominio en los campos inferiores

The pandemia caused by the SARS-CoV-2 virus has triggered an unprecedented health and economic crisis. Although the diagnosis of infection with SARS-CoV-2 is microbiological, imaging techniques play an important role in supporting the diagnosis, grading the severity of disease, guiding treatment, detecting complications, and evaluating the response to treatment. The lungs are the main organ involved, and chest X-rays, whether obtained in conventional X-ray suites or with portable units, are the first-line imaging test because they are widely available and economical. Chest CT is more sensitive than plain chest X-rays, and CT studies make it possible to identify complications in addition to pulmonary involvement, as well as to suggestive alternative diagnoses. The most common radiologic findings in COVID-19 are airspace opacities (consolidations and/or ground-glass opacities), which are typically bilateral, peripheral, and located primarily in the lower fields

The usefulness and positive predictive value of ultrasonography and computed tomography in the diagnosis of acute appendicitis in adults: a retrospective study. / Estudio retrospectivo y comparativo de la utilidad y del valor predictivo positivo de la ecografía y la tomografía computarizada en el diagnóstico de apendicitis aguda en adultos.

OBJECTIVE: To analyze the evolution of the use of imaging tests (ultrasonography and computed tomography (CT)) in the diagnosis of acute appendicitis. To determine the positive predictive value of these tests and the percentage of negative and complicated appendectomies. MATERIAL AND METHODS: This retrospective study compared adults who underwent appendectomy for suspected acute appendicitis at our tertiary hospital during 2015 versus similar patients at our center during 2007. RESULTS: A total of 278 patients were included. The rate of negative appendectomies descended to 5%. The positive predictive value of ultrasonography increased to 97.4% in 2015, and the positive predictive value of CT and combined CT and ultrasonography was 100%. The rate of complicated appendicitis increased (23% in 2015). CONCLUSIONS: The use of imaging tests increased, and the rate of "blind" laparotomies decreased. Nevertheless, the rate of complicated appendicitis increased.

Fístula aortoentérica: espectro de hallazgos en tomografía computarizada multidetector / Aortoenteric fistulas: spectrum of MDCT findings

Una fístula aortoentérica (FAE) es una comunicación aberrante entre la aorta y la pared del tubo digestivo. Se trata de una entidad rara pero con alta mortalidad que requiere, por tanto, un diagnóstico certero y precoz. Se clasifica como primaria si se desarrolla sobre una aorta nativa no intervenida previamente o como secundaria cuando ocurre en un contexto de complicación posquirúrgica de reparación vascular. Todo radiólogo debería saber reconocer los signos directos e indirectos que pudieran sugerir la existencia de una FAE. En este artículo se revisan los tipos de FAE y su correlación clínico-fisiopatológica, así como el algoritmo diagnóstico exponiendo los hallazgos radiológicos típicos en tomografía computarizada

An aortoenteric fistula is an abnormal communication between the aorta and the gastrointestinal tract wall. The high mortality associated with this rare entity means it requires early accurate diagnosis. Aortoenteric fistulas are classified as primary when they develop on a native aorta that has not undergone an intervention and as secondary when they develop after vascular repair surgery. All radiologists need to be able to recognize the direct and indirect signs that might suggest the presence of an aortoenteric fistula. This article reviews the types of aortoenteric fistulas and their clinical and pathophysiological correlation, as well as the diagnostic algorithm, illustrating the most characteristic findings on multidetector computed tomography

Aortoenteric fistulas: spectrum of MDCT findings. / Fístula aortoentérica: Espectro de hallazgos en tomografía computarizada multidetector.

An aortoenteric fistula is an abnormal communication between the aorta and the gastrointestinal tract wall. The high mortality associated with this rare entity means it requires early accurate diagnosis. Aortoenteric fistulas are classified as primary when they develop on a native aorta that has not undergone an intervention and as secondary when they develop after vascular repair surgery. All radiologists need to be able to recognize the direct and indirect signs that might suggest the presence of an aortoenteric fistula. This article reviews the types of aortoenteric fistulas and their clinical and pathophysiological correlation, as well as the diagnostic algorithm, illustrating the most characteristic findings on multidetector computed tomography.

Tromboembolismo pulmonar en pacientes con COVID-19: estudio de prevalencia en un hospital terciario / Pulmonary embolisms in patients with COVID-19: a prevalence study in a tertiary hospital

INTRODUCCIÓN: El coronavirus SARS-CoV-2, responsable de la pandemia actual, afecta preferentemente al tracto respiratorio, con un número creciente de publicaciones sobre su predisposición a fenómenos trombóticos. OBJETIVO: Conocer la prevalencia de tromboembolismo pulmonar (TEP) en pacientes con COVID-19; determinar su posible relación con la gravedad de la enfermedad pulmonar y los niveles de dímeros D, y analizar la localización del TEP en pacientes con COVID-19 comparándolos con los pacientes sin COVID-19. MÉTODO: Estudio retrospectivo de todas las angio-TC de arterias pulmonares realizadas por sospecha de TEP del 15 de marzo al 30 de abril de 2020. Se compara con las angio-TC realizadas durante el mismo periodo en 2019. RESULTADOS: Se incluyeron 492 angio-TC pulmonares, 342 (69,9%) de pacientes con COVID-19 y 147 (30,1%) de pacientes sin infección. La prevalencia de TEP fue del 26% en el grupo COVID-19 positivo y del 16,3% en el negativo (p = 0,0197), con un riesgo relativo de 1,6 veces. La prevalencia de TEP en el mismo período del año 2019 fue del 13,2%, similar a la del grupo COVID-19 negativo del año 2020 (p = 0,43). No hubo diferencias significativas en el nivel de dímeros D ni en la localización del TEP entre ambos grupos. El 78,7% de los pacientes con COVID-19 con TEP mostraron una extensión de la afectación pulmonar moderada o grave en la tomografía computarizada. CONCLUSIONES: Los pacientes con COVID-19 tienen una prevalencia aumentada de TEP (26%) y la mayoría (78,7%) presentan una extensión moderada o grave de afectación pulmonar en la tomografía computarizada. No hay diferencias significativas en la localización del material embólico ni en el grado de elevación de dímero-D respecto a los pacientes sin COVID-19

INTRODUCTION: SARS-CoV-2, the virus responsible for the current pandemic, predominantly affects the respiratory tract, and a growing number of publications report the predisposition of patients with COVID-19 to develop thrombotic phenomena. OBJECTIVE: To determine the prevalence of pulmonary embolism in patients with COVID-19; to determine the possible relationship between the severity of pulmonary involvement and D-dimer levels; to analyze the location of pulmonary embolisms in patients with COVID-19 and to compare it with the location in patients without COVID-19. METHODS: This retrospective study analyzed all CT angiograms of the pulmonary arteries done in patients with suspected pulmonary embolisms between March 15 and April 30, 2020 and compared them with studies done in the same period one year earlier. RESULTS: We included 492 pulmonary CT angiograms (342 (69.9%) in patients with COVID-19 and 147 (30.1%) in patients without COVID-19). The prevalence of pulmonary embolisms was higher in patients with COVID-19 (26% vs. 16.3% in patients without COVID-19, p = 0.0197; relative risk=1.6). The prevalence of pulmonary embolisms in the same period in 2019 was 13.2%, similar to that of the group of COVID-19-negative patients in 2020 (p = 0.43). There were no significant differences in D-dimer levels or the location of pulmonary embolisms between the two groups. CT showed moderate or severe pulmonary involvement in 78.7% of the patients with COVID-19. CONCLUSIONS: Patients with COVID-19 have an increased prevalence of pulmonary embolisms (26%), and most (78.7%) have moderate or severe lung involvement on CT studies. The location of pulmonary embolisms and the degree of elevation of D-dimer levels does not differ between patients with COVID-19 and those without

Vólvulos del tracto gastrointestinal. Diagnóstico y correlación entre radiología simple y tomografía computarizada multidetector / Gastrointestinal tract volvulus: diagnosis and correlation between plain-film X-ray and multidetector computed tomography findings

Los vólvulos del tracto gastrointestinal constituyen una causa importante de abdomen agudo, no tanto por su frecuencia como por la gravedad de sus posibles complicaciones. Todos ellos tienen un mecanismo fisiopatológico común que consiste en una obstrucción intestinal en asa cerrada que provoca una isquemia. Las manifestaciones clínicas son inespecíficas por lo que el radiólogo tiene un papel muy importante para identificar precozmente los signos de torsión más comunes, como «el pico de pájaro» o «el remolino», y los signos de isquemia potencialmente reversible o irreversible. El tratamiento de elección en la mayoría de los casos es quirúrgico, bien para corregir las causas y preservar el órgano volvulado, o para resecarlo en caso de necrosis (AU)

Gastrointestinal volvuli cause processes that manifest as acute abdomen. Volvuli are important not because they are common, but rather because their possible complications can be severe. All types of volvuli share a common pathophysiology, which consists of intestinal obstruction in a closed loop that results in ischemia. The clinical manifestations are nonspecific, so radiologists play a very important role in the early identification of the most common signs of torsion. These include the «bird's beak sign», the «whirlpool sign», and signs of potentially reversible or irreversible ischemia. The treatment of choice in most cases is surgery, either to correct the torsion and save the organ or to resect it if it is necrotic (AU)

[Gastrointestinal tract volvulus: diagnosis and correlation between plain-film X-ray and multidetector computed tomography findings]. / Vólvulos del tracto gastrointestinal. Diagnóstico y correlación entre radiología simple y tomografía computarizada multidetector.

Gastrointestinal volvuli cause processes that manifest as acute abdomen. Volvuli are important not because they are common, but rather because their possible complications can be severe. All types of volvuli share a common pathophysiology, which consists of intestinal obstruction in a closed loop that results in ischemia. The clinical manifestations are nonspecific, so radiologists play a very important role in the early identification of the most common signs of torsion. These include the "bird's beak sign", the "whirlpool sign", and signs of potentially reversible or irreversible ischemia. The treatment of choice in most cases is surgery, either to correct the torsion and save the organ or to resect it if it is necrotic.

Dilatación unilateral completa de conducto deferente como causa de masa inguinal / Complete unilateral dilation of the vas deferens as a cause of an inguinal mass

La dilatación completa unilateral del conducto deferente es un hallazgo radiológico extremadamente raro. La mayoría de las estructuras quísticas adyacentes a la próstata se pueden agrupar en quistes y divertículos. El hallazgo de masas inguinales obliga a descartar la existencia, entre otras entidades, de hernia intestinal. Presentamos el caso de un paciente con masa inguinal secundaria a conducto deferente dilatado de manera unilateral (AU)

The complete unilateral dilation of the vas deferens is an extremely rare radiologic finding. Most cystic structures adjacent to the prostate can be grouped into cysts and diverticula. The finding of an inguinal mass makes it necessary to rule out intestinal hernias and other entities. We present the case of a patient who developed an inguinal mass secondary to unilateral dilation of the vas deferens (AU)

[Complete unilateral dilation of the vas deferens as a cause of an inguinal mass]. / Dilatación unilateral completa de conducto deferente como causa de masa inguinal.

The complete unilateral dilation of the vas deferens is an extremely rare radiologic finding. Most cystic structures adjacent to the prostate can be grouped into cysts and diverticula. The finding of an inguinal mass makes it necessary to rule out intestinal hernias and other entities. We present the case of a patient who developed an inguinal mass secondary to unilateral dilation of the vas deferens.

[Multidetector computed tomography in acute abdomen]. / La tomografía computarizada multidetector en el abdomen agudo.

MDCT has become a fundamental tool for determining the causes of acute abdomen. CT is considered the imaging technique of choice in the diagnostic workup of both localized and diffuse acute abdomen, except in patients in whom acute cholecystitis or acute gynecological disease is suspected and in children, adolescents, and pregnant patients, in whom ultrasonography is the imaging technique of choice. Plain-film X-ray examination has been relegated to the initial management of renal colic, suspected foreign bodies, and intestinal obstruction. One of the drawbacks of MDCT is its use of ionizing radiation, which makes it necessary to filter and direct the examinations as well as to ensure that the most appropriate protocols are used. For this reason, low dose protocols have been developed so that diagnostic studies can be performed with doses of radiation between 2 and 3 mSv; these are normally used in the diagnosis of renal colic and can also be used in selected patients with suspected appendicitis and acute diverticulitis.

La tomografía computarizada multidetector en el abdomen agudo / Multidetector computed tomography in acute abdomen

La TCMD se ha convertido en la herramienta fundamental en el diagnóstico de las causas de abdomen agudo. Se considera que la TC es la técnica de elección en el diagnóstico del dolor abdominal agudo tanto localizado como difuso, excepto cuando la sospecha es la colecistitis aguda, la patología ginecológica aguda, así como el dolor abdominal en niños, jóvenes y embarazadas, donde la ecografía es la exploración de elección. La radiología convencional ha quedado relegada al manejo inicial del cólico renal, sospecha de cuerpos extraños y obstrucción intestinal. Uno de los inconvenientes de la TCMD es la utilización de radiaciones ionizantes, lo que obliga a filtrar y dirigir las exploraciones así como a utilizar los protocolos más adecuados. Por ello se han desarrollado los protocolos de baja dosis con los que se pueden realizar estudios diagnósticos con una dosis de radiación de 2-3 mSv que se emplean de forma generalizada en el diagnóstico del cólico renal y pueden utilizarse también en pacientes seleccionados con sospecha de apendicitis y diverticulitis aguda. MDCT has become a fundamental tool for determining the causes of acute abdomen (AU)

CT is considered the imaging technique of choice in the diagnostic workup of both localized and diffuse acute abdomen, except in patients in whom acute cholecystitis or acute gynecological disease is suspected and in children, adolescents, and pregnant patients, in whom ultrasonography is the imaging technique of choice. Plain-film X-ray examination has been relegated to the initial management of renal colic, suspected foreign bodies, and intestinal obstruction. One of the drawbacks of MDCT is its use of ionizing radiation, which makes it necessary to filter and direct the examinations as well as to ensure that the most appropriate protocols are used. For this reason, low dose protocols have been developed so that diagnostic studies can be performed with doses of radiation between 2 and 3 mSv; these are normally used in the diagnosis of renal colic and can also be used in selected patients with suspected appendicitis and acute diverticulitis (AU)

Manejo conservador de las lesiones esplénicas: experiencia en 136 pacientes con traumatismo esplénico cerrado / Conservative management of splenic lesions: experience in 136 patients with blunt splenic injury

Objetivo. Evaluar la eficacia de las pruebas de imagen en la selección del manejo terapéutico de los pacientes. Relacionar el grado de lesión esplénica con el tratamiento instaurado. Exponer los beneficios de la embolización en el trauma esplénico. Material y métodos. Se han estudiado retrospectivamente un total de 136 lesiones esplénicas. Se analizaron los principales mecanismos lesionales, los hallazgos de imagen obtenidos mediante ecografía FAST y TC, el espectro lesional, el manejo terapéutico y la evolución. Resultados. La edad media fue 34,81 años y el principal mecanismo lesional los accidentes de tráfico. El 39,70% de los casos (54 pacientes) mostraban signos de inestabilidad hemodinámica, y el 60,30% restante (82 pacientes) estaban estables o respondían a maniobras de resucitación. La ecografía FAST fue la técnica de imagen inicial y más utilizada en los pacientes inestables, mientras que la TC fue la técnica más empleada en los pacientes estables. El tratamiento fue quirúrgico en el 79,99% de las lesiones de alto grado y conservador expectante en el 55,69% de las lesiones de bajo grado. El 8,54% de los pacientes estables se manejó con arteriografía y embolización. Conclusión. La ecografía FAST demostró ser una técnica decisiva en la elección del tratamiento quirúrgico en los enfermos inestables. Las lesiones de alto grado se asociaron con mayor frecuencia a un tratamiento quirúrgico y las de bajo grado a un manejo no quirúrgico. La arteriografía con embolización demostró ser una terapia eficaz en el tratamiento de lesiones vasculares en enfermos estables (AU)

Objective. To evaluate the usefulness of imaging tests in selecting the treatment for patients with blunt splenic trauma. To relate the grade of splenic lesion with the treatment. To describe the benefits of embolization in splenic trauma. Material and methods. We retrospectively studied 136 splenic lesions. We analyzed the main mechanisms of injury, the imaging findings at focused assessment with sonography for trauma (FAST US) and CT, the spectrum of lesions, the therapeutic management, and the outcome. Results. The mean age of patients was 34.81 years and the most common mechanism of injury was traffic accidents. Signs of hemodynamic instability were observed in 54 (39.70%) patients; the remaining 82 (60.30%) patients remained stable or responded to resuscitation. FAST US was the initial imaging technique and the most commonly used technique in unstable patients, whereas CT was the most commonly used technique in stable patients. Surgical treatment was used in 79.99% of the high grade lesions and conservative treatment was used in 55.69% of the low grade lesions. Angiography and embolization were used to manage 8.54% of the stable patients. Conclusion. FAST US is decisive in choosing the surgical treatment in unstable patients. High grade lesions are associated with a higher frequency of surgery and lower grade lesions are associated with a higher frequency of nonsurgical management. Angiography with embolization is efficacious in the treatment of vascular lesions in stable patients (AU)

[Conservative management of splenic lesions: experience in 136 patients with blunt splenic injury]. / Manejo conservador de las lesiones esplénicas: experiencia en 136 pacientes con traumatismo esplénico cerrado.

OBJECTIVE: To evaluate the usefulness of imaging tests in selecting the treatment for patients with blunt splenic trauma. To relate the grade of splenic lesion with the treatment. To describe the benefits of embolization in splenic trauma. MATERIAL AND METHODS: We retrospectively studied 136 splenic lesions. We analyzed the main mechanisms of injury, the imaging findings at focused assessment with sonography for trauma (FAST US) and CT, the spectrum of lesions, the therapeutic management, and the outcome. RESULTS: The mean age of patients was 34.81 years and the most common mechanism of injury was traffic accidents. Signs of hemodynamic instability were observed in 54 (39.70%) patients; the remaining 82 (60.30%) patients remained stable or responded to resuscitation. FAST US was the initial imaging technique and the most commonly used technique in unstable patients, whereas CT was the most commonly used technique in stable patients. Surgical treatment was used in 79.99% of the high grade lesions and conservative treatment was used in 55.69% of the low grade lesions. Angiography and embolization were used to manage 8.54% of the stable patients. CONCLUSION: FAST US is decisive in choosing the surgical treatment in unstable patients. High grade lesions are associated with a higher frequency of surgery and lower grade lesions are associated with a higher frequency of nonsurgical management. Angiography with embolization is efficacious in the treatment of vascular lesions in stable patients.